Community Development Innovation Review

April 2013

Can Pay for Success Reduce Asthma Emergencies and Reset a Broken Health Care System?


I blame Len Syme and the social epidemiologists for disrupting my otherwise steady trajectory as a high-flying health insurance executive. It was Len, the University of California Berkeley professor emeritus, who spoiled for me the simple notion that “access to high-quality, affordable care” (our industry mantra) would solve our nation’s health crisis. Medical care, it turns out, accounts for just 10 percent of what makes us healthy or sick. So what’s the other 90 percent? It’s a pretty gnarly sweater once you start unraveling it. After nearly a decade in health insurance, I left the comfy confines of my corporate office to follow a thread Len so eloquently describes as “intricately and infinitely intertwined” with our social, economic, and environmental circumstances. What matters most to health is the context in which we live our lives. This calls for a profoundly different health delivery and financing system, I’ve come to learn, with some pretty hefty obstacles in the way. But it is possible to meet these challenges. In this article, I look at a path forward for one chronic condition, childhood asthma, and the potential for spreading this approach to the broader health system.

Download the article (pdf, 450.46 kb)

Other articles in this issue

Community Reinvestment Act (CRA) Banks as Pioneer Investors in Pay for Success Financing

The Real Revolution of Pay for Success: Ending 40 Years of Stagnant Results for Communities

Pay for Success is Not a Panacea

The Promise of Pay for Success

Social Impact Bonds: Lessons Learned So Far

Pay for Success: Understanding the Risk Trade-offs

The Ethics of Pay for Success

Learning from the Low Income Housing Tax Credit: Building a New Social Investment Model

Using Social Impact Bonds to Spur Innovation, Knowledge Building, and Accountability

Social Impact Bonds: Using Impact Investment to Expand Effective Social Programs

Innovation Needs Foundation Support: The Case of Social Impact Bonds

Pay for Success: Opportunities and Risks for Nonprofits

Success Begins with a Feasibility Study

Government’s Role in Pay for Success

Rikers Island: The First Social Impact Bond in the United States

Human Capital Performance Bonds

Pay for Success: Building On 25 Years of Experience with the Low Income Housing Tax Credit

Supporting At-Risk Youth: A Provider’s Perspective on Pay for Success

Tax Increment Finance: A Success-Driven Tool for Catalyzing Economic Development and Social Transformation

Bringing Success to Scale: Pay for Success and Housing Homeless Individuals in Massachusetts

Making Performance-Based Contracting Work for Kids and Families